Schizophrenia prodrome is an early or prepsychotic state that is a deviation from an individual’s usual behavior and experience.1 Prepsychotic patients can differentiate reality from fantasy but gradually lose this ability as their illness progresses.2 Therefore, early identification and treatment of prepsychotic adolescents and those with early psychosis can reduce social withdrawal, isolation, and psychosocial morbidity and mortality.
Detective work
Probing for possible paranoia and psychotic symptoms in adolescents who do not present with these complaints can be challenging. Maintain rapport as you probe for unusual thought content and delusional ideas by inquiring about your patient’s “experiences” rather than the more pejorative term “problems.” Some prodromal patients may be at imminent risk of conversion to psychosis and continued deterioration. The following questions that are based on prodrome assessment scales1,3 can help detect emerging psychosis.
Thinking can be evaluated by asking:
- Do you feel that you or people around you have changed in a way you can’t explain?
- Do people seem alien or evil?
- Have you been confused about whether something is real or imaginary?
- Do you daydream a lot?
- Are you preoccupied with stories or ideas?
- How are others treating you?
- Do you feel that people think about you in a negative way?
- Do you feel singled out?
- Do you feel that you must be vigilant around others to be safe?
- How do you spend your free time?
- How often do you talk with friends and family?
- What groups do you participate in?
- How friendly are others at school or work?
Ask your patient about computer use, especially favorite Web sites and electronic games. Some alienated and schizoid adolescents may be heavily involved in role-playing fantasy electronic games.4 Loners may fill their free time in cyberspace.
Perceptual abnormalities and hallucinations can be determined by asking:
- Do you ever feel your mind plays tricks on you?
- Do you hear unusual sounds?
- Do you ever hear your name being called when no one is there?
- Do you feel a presence around you?
- Do you ever see people or things but realize they may not be real?
- Do you feel numb?
- Do you feel disconnected from yourself or your life, as if you are a spectator?
- Do you lack rapport with others?
- Are you bored?
Estimate deteriorating role functioning by inquiring about problems completing assignments and impaired tolerance of normal stress.
- Do you avoid or feel overwhelmed by situations that previously you could deal with?
- Is it harder to get through the day?
- Are you easily thrown off by unexpected events?